Application, Medical Questionnaire, Release, Waiver of Liability and Indemnity Agreement with Faith-Fitness Bootcamp. Full Name ______________________________________________________ Date of Birth _____________ Street Address _______________________________________________ City __________________________________________________ State____________ Zip______________________ Home Phone #__________________________ Cell Phone #__________________________ Email_____________________________________________ I understand that it is my responsibility to consult with a physician prior to and regarding my participating in the fitness classes and boot camp classes with Faith-Fitness Bootcamp and to receive prior approval to participate. I represent and warrant that I am physically fit and I have no medical condition or injury, which would prevent my full participation in the fitness classes and boot camp classes Faith-Fitness Bootcamp. Personal Health History Do you have any additional conditions that may prevent you from performing fitness training and boot camp classes? For example, knee problems, heart condition, etc: __________________________________________________________ __________________________________________________________ __________________________________________________________ I understand that it is my continuing responsibility to inform the instructor(s) at Faith-Fitness Bootcamp_ of any previous medical conditions, injuries or surgeries prior to my first class and at such other times as I acquire information as to same. Have you participated in a boot camp class before this class? [ ] YES [ ] NO For and in consideration of being allowed to receive fitness training and boot camp classes from Faith- Fitness Bootcamp, and the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned ____________________ (client) agrees to the following: 1. I, _____________________ (client), do fully comprehend and assume all risks involved in participating in fitness training and boot camp classes. I have been advised by Faith-Fitness Bootcamp, to consult my
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Application, Medical Questionnaire, Release, Waiver of Liability and Indemnity
Agreement with Faith-Fitness Bootcamp.
Full Name ______________________________________________________
Date of Birth _____________
Street Address _______________________________________________
City __________________________________________________